By Violet Oaklander PhD
A process of therapy has emerged through analysis of the author’s work with children and adolescents over a span of nearly 40 years. This process fits organically with the philosophy, theory and practice of Gestalt Therapy, beginning with the prerequisite of the relationship between the client and therapist. The role of contact and its connection to resistance is examined as particularly applied to the specific characteristics of children. The author has found that the continuous strengthening of the child’s inner support structure in the course of therapy is fundamental to the child’s ability to work through deep-seated, blocked emotions. Therefore, enhancing the child’s sense of self is a crucial step toward healthy emotional expression and optimum growth and development. The focus on self-enhancement through specific experiences inherent in child development are an intrinsic part of psychotherapy with children and adolescents. Even the task of helping the child feel safe and comfortable with expressing feelings require its own sequence. The author discusses a method for helping the child become self-nurturing, an important component of the therapeutic process and one often neglected in Gestalt Therapy, yet particularly critical to the child who has suffered trauma. Finally, the therapeutic process concludes with termination, never actually a final step since children can only deal with specific issues in accordance with their particular development stage.
Nothing happens without at least a thread of relationship. The relationship is a tenuous thing which takes careful nurturing. It is the foundation of the therapeutic process and can, in of itself, be powerfully therapeutic. This I/Thou relationship, based on the writings of Martin Bauber (1958). has certain fundamental principles that are highly significant in work with children. We meet each other as two separate individuals, one not more superior than the other. It is my responsibility to hold this stance. I am as authentic as I know how to be – I am myself. I don’t use a teacher voice or a patronising voice. I will not manipulate or judge. Although I am perpetually optimistic regarding the healthy potential of the child that I meet in my office, I will not place expectations upon her. I will accept her as she is; in whatever way she presents herself to me. I will respect her rhythm and in fact, attempt to join her in that rhythm; I will be present and contactful. In this way our relationship flourishes.
Transference generally enters into any relationship, however I do not encourage it. The child may react to me as a parent figure; however, I am not her parent. I have my own point of view, my own limits and boundaries, my own way of responding. In relating to my client as a separate being, I give her the opportunity to experience her own SELF, her own boundaries - to perhaps experience herself in a new way. I am not hopelessly enmeshed with her, as a parent might be. As I maintain my own integrity as a separate person, I give the client the opportunity to experience more of her own self, thus enhancing her sense of self and improving and strengthening her contact skills.
Further, I have a responsibility to be aware of any ‘buttons’ pressed in me that may not be genuine emotional responses to the contextual situation, and to explore these counter transference responses to eliminate their detriment to the client. I am true to myself as well. I am not afraid of my own feelings and responses, and I know my own limits. I honour what’s important to me. We begin on time and end on time. I pace the session so that there is time for the child to help me clean up (except sand tray scenes). In this way closure is clearly evident.
Once the initial resistance is overcome, I can begin to feel that thread of relationship with most children. However, there are some children who cannot form a relationship, at least for some time. These are children who have been severely injured emotionally at a very early age, or perhaps at birth. Trust eludes them. For these children, the focus of the child’s resistance is vital, for it is the one way that the child has learned to protect herself. Finding creative, non-threatening ways to reach the child is the task of the therapist.
The next issue that I address in the therapeutic process is that of contact. Is the child able to make and sustain good contact? Or does he move in and out of contact, or have difficulty making contact at all? In every session together, contact is a vital, existential issue. Nothing much happens without some contact present. What happens outside the session may be similar or different, and I can only work with what we have together. Sometimes a child has so much difficulty sustaining contact with me that the focus of the therapy becomes one of helping the child feel comfortable with making and sustaining contact.
Contact Involves having the ability to be fully present in a particular situation with all of the aspects of the organism – senses, body, emotional expression, intellect – ready and available for use. Children who have troubles, who are worried and anxious, frightened, grieving or angry, will armour and restrict themselves, pull themselves in, cut parts of themselves off, inhibit healthful expression. When the senses and the body are restricted, emotional expression and a strong sense of self, will be negligible.
Good contact also involves the ability to withdraw appropriately rather than to become rigidified in a supposedly contactful space. When this happens it is no longer contact, but a phony attempt to stay in contact. An example of this is the child who never stops talking, or who can never play alone and needs to be with people at all times.
We speak of contact skills – the how of contact. These skills involve touching, looking and seeing, listening and hearing, tasting, smelling, speaking, sound, gesture and language, moving in the environment. Sometimes in our therapeutic journey it is necessary to give children many experiences to open the pathways to contact. Children who have been abused particularly desensitise themselves, as do most children who have experienced some kind of trauma.
Sometimes I will notice that a child, who generally has the capacity to make good contact, will come into the session and appear to be distracted. I will know immediately that something amiss has happened prior to this time. I might casually ask the child to tell me something that has happened at school that he didn’t like, or something that happened on the way to my office. I need to assess the child’s contact level at each meeting.
Children evidence a variety of behavioural manifestations, often called resistances, as their way of attempting to cope and survive and make contact with the world as best they can. Sometimes it works, but more often children do not get what they need as they engage in these behaviours. They are considered inappropriate by others, and only make things worse. Since they have little awareness of cause and effect, they try harder, generally by accelerating the behaviours, but their efforts fail them, and life is far from satisfying. As they gain more self-support through a stronger sense of self, the unsuccessful behaviours drop away and are replaced by more satisfying, effective ways of contacting the world. Most every child will be resistant, self-protecting, to some degree. If there is no resistance whatsoever, I know that this child’s self is so fragile that she must do whatever she is told to do in order to feel that she can survive. I want to help this child strengthen herself so that she can feel some resistance, to have enough support to pause and consider.
Resistance is the child’s ally. It is the way she takes care of herself. I expect resistance and I respect the resistance. I am more often surprised when it is not there, than when it is. In some situations I articulate it for the child, ‘I know you probably don’t want to do this drawing, but I want you to do it anyway. Whatever you do, I don’t want you to do your best we just don’t have time for that.’ I want to help the child soften somewhat, and go through the resistance to some degree for a little while. The very fact that I will accept the child’s resistance often helps her take the risk to do something new.
As the child begins to feel safe in our sessions, she will drop the resistance for a time. However, when she has experienced or divulged as much as she can handle, as much as she has inside support for, the resistance will come up again. In this way, resistance surfaces over and over again, and each time it must be honoured. We cannot force the child to go beyond her capabilities. Resistance is also a sign that beyond this place of defense, there is highly significant material to be explored and worked through. The child seems to know on some intuitive, visceral level when she can handle such material and I have learned to trust this process. As we work with sell- expression and emotional expression activities, the issues emerge again and again. The therapeutic work with the child is accomplished in small segments.
I see resistance as a manifestation of energy as well as an indication of the contact level of the child. As the child engages with me or some activity or technique, there suddenly may be a perceivable drop in energy, and contact shifts away from me or the task in hand. I can often see this manifestation before the child’s own awareness, by observing his body responses at that moment. I may say, ‘Let’s stop this for now and play a game,’ to the great relief of the child (obvious through the body). He is back in contact with me. Some children show their resistance in passive ways; that is, they will ignore, act distracted, seemingly not hear what I say, or begin to, without response, do something other than what I have suggested. If that child finally comes to a place where she can say clearly ‘No. I don’t want to do that,’ I will quickly reinforce that direct, contactful statement by immediately honouring it.
To enhance tactile sensation I might encourage the child to fingerpaint or work with pottery clay, using lots of water. We might sit at the sand tray running our hands through the sand as we talk. I might bring in a variety of textures to touch and compare, or we might examine various textures right in the office. We might listen to sounds in and outside the office or the sounds of music or drums. We might look at flowers. colours, pictures, light, shadow, objects, each other. Books on early childhood education provide a wealth of ideas for activities to enhance the senses, and are effective with people of all ages.
In my book, Windows to Our Children (1978, 1988), I describe how I made use of the Orange Exercise to open and enhance the senses. I gave each child in a group an orange. Slowly we investigated every aspect of the orange, examining it, smelling it, weighing it, feeling its temperature and texture, licking it. We peeled off the skin and examined it very carefully, biting and tasting it. We peeled the fibrous layer and examined this. We marvelled at the shiny, protective layer over the orange, noting that it had no taste. We divided each orange into segments, took a segment and very carefully went through the examination procedure. We then traded segments with everyone in the group, discovering in amazement that each segment was different in taste and texture, though all delicious. One twelve year old girl remarked later, ‘I can never eat an orange, or any other fruit, the way I used to anymore. Now I really know it.’ This child was referring to her enhanced awareness and sharpened sensory capabilities.
When children feel safe in my office, they will often regress and allow themselves to have experiences that one may deem more appropriate for a younger child. When this happens, I celebrate inside myself. Children who live in dysfunctional families, or who have been traumatised in some way, tend to grow up too fast. They skip over many important development steps. Some children will pour lots of water on the clay, unconsciously replicating mud play. Others will use water in fairly creative ways. A twelve year old boy, after learning that he had to help me clean up, insisted on washing all the clay tools. I told him that I don’t usually wash them but he insisted. As I watched him at the sink, I was reminded of my three year old daughter standing on a stool at the sink washing her toy dishes. This boy did not need a stool but he was involved in the washing as much as my daughter had been. He was giving himself an experience that he needed; this was evident by his relaxed body and smiling face.
Our next focus is the body. Every emotion has a body connection. Notice how your body reacts the next time you feel angry or joyous. Notice the constriction of your head when you hold in your anger. Notice the tightening of the throat and chest as you fend off tears, the hunching of the shoulders when you feel anxious or frightened. Children develop body patterns at an early age, often creating at that time the defects in postures that we usually see more clearly in adolescents and adulthood.
Children who are troubled restrict their bodies and become disconnected from them. I want to help them unblock, loosen up, breathe deeply, know their own bodies, feel proud of that body, feel the power that lies within that body. Often we begin with breath. Children, and adults, when anxious or fearful, restrict the breath, thus cutting themselves off further from themselves. We invent games that involve breathing. We do breathing exercises. We blow up balloons and move through the air with our breath to see who can keep the balloon up the longest. We do relaxation, meditative exercises involving the breath. We blow cotton wool balls across a table to see whose will reach the end first. We play games involving making sounds, singing and screamimg. Adolescents in particular are fascinated by the power of the breath. Over and over again, they will tell me how they remembered to breath deeply, imagining the breath bathing the body and the brain, during school examinations and how helpful this was to them. The secondary gain of feeling over one’s life, rather than a victim of it, is unmeasurable.
We do many exercises involving the body. We might dance around the room, throw a ‘Nerf®’ ball, fall on pillows, have a ‘Bataca®’ fight, play a hand wrestling game. Hyperactive children particularly benefit from controlled body experiments such as yoga, or body movement games when they can experience body control with movement. Bed wetters benefit greatly from body work since they are generally quite disconnected from their bodies. Creative dramatics, particularly pantomime, is a tremendous aid for helping children know their bodies. Each movement must be exaggerated in order to get the idea across. We play many games involving mime.
We don’t necessarily spend a whole session doing sensory, breathing and body activities. If it appears indicated, I will suggest an activity which the child may or may not be willing to do. Much depends on my own enthusiasm and willingness to involve myself in these activities with the child, as well as my skill in presenting them. We may spend five minutes or a whole session with these activities. We may need to negotiate and compromise, spending part of the time with what the child wants to do, and part with what I suggest. Once the child allows himself to be involved in these experiences, he generally enjoys them greatly. Therapy with children is like a dance; sometimes I lead and sometimes the child leads.
Strengthening the self
Helping the child develop a strong sense of self is a major prerequisite in helping him express buried emotions. Further, the child begins to feel a sense of wellbeing as well as a positive feeling about himself. Let me remind you that these steps as outlined in this discussion of the therapeutic process are not at all consecutive. We go back and forth as needed. We may be focusing on sensory work, and while the child is enjoying the tactile sensation of wet clay, for example, along with the kinesthetic experience inherent in working with pottery clay, he may feel an increased sense of self. This heightened feeling of self will often spontaneously evoke emotional expression.
Strengthening the self involves, besides sensory and body experiences:
- Defining the self
- Experiencing some power and control
- Making choices
- Experiencing mastery
- Owning projections
- The setting of boundaries and limits
- Having the ability to be playful and use the imagination
- Contacting one’s own aggressive energy
Defining the self
To empower the self one must know the self. Many experiences are provided to help children make ‘self’ statements. The child is encouraged to talk about herself through drawing, collage, clay, puppets, creative dramatics, music, metaphor, dreams, in fact, any technique that will help the child focus on herself. ‘This is who I am’ and ‘This is who I am not’ is what the child is learning and integrating into her awareness.
I make lists that the child dictates to me, of foods she likes and foods she hates, things she doesn’t like about school and things she does like, if any. The child might draw a picture of all the things she wishes for, or what makes her happy or sad or angry or afraid, or all the things she likes to do. Or I might ask the child to make out of clay, figures or abstract shapes to represent herself when she feels good and when she feels bad.
Honouring the child’s thoughts, opinions, ideas and suggestions is an important aspect of strengthening the self. Sometimes, with adolescents, I will use an astrology book, or the manual after giving them a projective test. I will read various sentences pertaining to their birth sign, or the manual’s interpretation of the test and will then ask, ‘Does this fit for you?’ Each time the child can say, ‘Yes, this is how I am,’ or ‘No, I’m not like that,’ or even ‘Well, sometimes I’m like that and sometimes I’m not,’ she is establishing more of who she is. The more the child can be assisted to define herself, the stronger the self becomes and there is more opportunity for healthful growth
Giving the child many opportunities to make choices is another way to provide inner strength. Many children are fearful of making even the most insignificant choices for fear of making a wrong one. So I will provide many non-threatening choices as I can; ‘Do you want to sit on the couch or at the table? Do you want markers or pastels?’ Later the choices become a bit more complicated; ‘Which size paper would you like? (three choices). What would you like to do today?’ A typical response may be ‘I don’t know.’ or I don’t care’, or ‘Whatever you want me to.’ I smile and patiently insist that they make a choice, unless, of course I see that it is just too painful to make such a decision at this time. I encourage parents to give their children the opportunity to make choices wherever possible.
Children who live in dysfunctional families or alcoholic families or who have been abused, neglected or molested often grow up too fast and skip over many important mastery experiences vital to healthy development. In some cases the parents may do too much for the child, thereby thwarting his need to struggle; other parents are so rigid they don’t allow the child to explore and experiment. Some parents believe that frustration improves staying power. Children never learn to accomplish tasks through frustration, and it is important to be sensitive to that point. The baby struggles to put the smaller box into the larger one, but when frustration sets in, he begins to cry. The older child loses energy – cuts off contact.
Mastery experiences come in many forms. Some are planned, as bringing in a new game and figuring it out together, building a structure out of ‘Lego’ or ‘Lincoln Logs’, or figuring out a puzzle. Some children, as they begin to feel safe with the therapist, create their own experiences, such as drowning the clay with water or intently washing clay tools. These kinds of experiences are closely related to regression. The child herself creates opportunities to relive the kinds of experiences she may have missed or needed more of. Sometimes mastery experiences present themselves spontaneously. An 11 year old boy, for example, attempted to make a model bird fly in a sand scene he was creating. He asked me for a stick and some string. I knew the string would not work, but wisely said nothing. He discovered, after many tries, that he couldn’t tie the bird to the top of the stick with string. His energy began to fade, his contact with the task was broken, and I knew that at any minute he would decide to stop working on his sand scene. Sensing the onset of his frustration, I said gently. ‘I have an idea that might work. Would you like to hear it?’ He nodded and I said, ‘Maybe wire would work or even something like masking tape. I don’t know – what do you think?’ The boy opted for some picture wire. It worked, and his energy and smile and big sigh indicated to me his mastery experience. I did not say, “Don’t forget, that was my idea”.
Of course, children who use many of the projective techniques experience mastery, not by my saying, ‘That’s a beautiful picture or a wonderful sand scene,’ but by their own intrinsic satisfaction. I caution parents to avoid overblown, general statements such as, ‘That’s a beautiful drawing’ or ‘You are a musical genius.’ Children generally turn such statements into negative introjects. More effective are statements such as, ‘I like the colours of that picture,’ or I like the way you have cleaned your room,’ staying with the ‘I’ message.
Many of the techniques we use are projective in nature. When a child makes a sand scene, draws a picture, or tells a story, he is tapping into his own individuality and experience. Often these expressions are metaphorical representations of his life. When he can own aspects of these projections, he is making a statement about himself and his process in life. His awareness of himself and his boundaries intensifies. When the child describes his safe-place drawing to me, he feels heard and respected as I listen carefully. When I ask him to give me a statement about his place that I can write on his picture, he feels further validated. When we connect his statement to his life today, he begins to feel his own significance in the world. From a 14 year old’s safe place drawing of an ice cave, I write as he dictates ‘I am walking through my ice cave and I am thinking.’ I ask him what he is thinking about. ‘I am thinking about everything – school, my life.’ I ask if anyone else is there. ‘No, no-one knows how to get here. I’m the only one who knows the way in and the way out.’ I ask how this place relates to the reality of his life. ‘I need a place like that. It’s hard for me to think about anything when my brother is around.’ (He is an identical twin.) He expands a bit about this situation and draws a picture representing how he feels when his brother is around – a tight mass of dark – coloured lines. He admits that he doesn’t know how to feel free without finding an ice cave in which to hide. We have come one step further toward helping this boy find and own himself.
Boundaries and Limits
Good parenting involves clear limit setting appropriate for the child’s age level so that the child can know, experiment and test her boundaries. When a boundary is not available, the child tends to feel anxious and may flail around in search of this boundary. Her sense of self becomes amorphous. The parents need to know when it is appropriate to stretch the boundaries so that the child, at each developmental level, can find new areas of exploration. In our sessions, my limits and boundaries are clear. We begin on time; we end on time. I do not answer the phone, in fact, they notice that I generally turn it off. My desk is off limits, and we don’t flick paint around the room. At the end of each session the child helps me clean up (except for sand tray scenes). Closure of the session is made clear by this activity. I don’t articulate these ‘rules’, they are dealt with naturally as they come up. I believe that my respect for myself and my limits free children to become more acquainted with themselves. I am also aware of my own limits in another way, I know, or sometimes learn in the process, what I can or cannot do. If I am required in a game to jump 100 times, I inform the child when I reach my limit. I also respect the child’s need to limit herself.
Playfulness, Imagination and Humour.
Young children naturally have a flair for playfulness and imagination and love to laugh at funny things. They have not restricted or inhibited themselves as yet. Imaginative play is an integral part of child development. Often these natural resources are stifled in children who are traumatised in some way. Providing many opportunities for imaginative play is a necessary component of child therapy and serves to free and enhance the self. The therapist needs to know how to play with the child. If this quality of life is obscured or lost, the therapist herself must find a way to regain this joyful behaviour. Fortunately, I have never lost the capacity for play, and this attribute has served me well with my own children with whom I’ve worked. Because there is so little opportunity in life to experience playfulness and imagination as an adult, I am very fortunate to have found my own avenues for these expressions. Many parents have difficulty allowing themselves to play joyfully with their children. When I am aware of this, we spend some time in my office just playing. I can be a good model for this activity.
As children begin to trust me and feel at home in my office, they begin to take over sessions This step is one of the most exciting parts of the therapy for me. When I see this happen, I know that there is progress. The children I work with (and actually most children) have no power over their lives. They might fight for control, engaging in power struggles, but actually these children feel a terrible lack of power. The kind of control that happens in the sessions is not the same as a fighting for power, it is a contactful interaction, but one where the child, in the play (and the child always knows it’s play), has the experience of control. It is one of the most self-affirming actions that takes place in our sessions.
Here is an example with a little bit of the child’s story. (In child work it is essential for me to know the child’s ‘story’ – his history, the life he comes from, the life he is in now. Without this understanding of the child’s field, the experience lacks connection and substance.)
Joey was found in an abandoned car when he was about 5 years old. He was tied to the seat with ropes, and it was concluded that he had been tied often and not allowed to move much, since his body showed evidence of rope burns, and his muscles were quite atrophied. He was close to death when found. After a time in hospital and two foster homes, he was adopted. (His birth parents were never found.) His adoptive parents brought him to therapy when he was 10 years old because of his extremely hyperactive behaviour (in spite of medication), as well as severe bouts of explosive and destructive anger.
Joey spent the first four sessions running round the room, picking things up and throwing them down. In these sessions my focus was to establish a relationship and help Joey sustain contact with me or something in the room and so I attempted to join him by running round the room with him, picking up the object he threw down, making a brief comment about it, and chasing after him to the next item. I noticed at the second session he paused for a second as I made my comment, and by the fourth session he had slowed down considerably and was actually responding and interacting with me. The relationship flourished, and we participated together in a number of sensory, contact enhancing activities. The musical instruments were a great favourite with Joey, and we spent some time communicating without words through the drums and other percussion instruments. He spent one whole session looking through a kaleidoscope, finding interesting designs, inviting me to look at them, and then waiting for me to find something he could look at (contactful episode par excellence).
Suddenly, everything changed and he began to take control of the sessions in a new way. He spotted a set of handcuffs and set the stage for an enactment. ‘You are a robber and I am the policeman. You steal this wallet (an old one on the shelf) and I come after you and catch you.’ So we played this game with great gusto with various new directions from Joey. He was clearly in charge.
At the second session we played out the scenario, he said ‘I wish I had some rope so that I could tie you up.’ I brought in some rope at the next session, and he gleefully tied me up. Once or twice I came out of my role to tell him the rope was too tight for me, and he quickly loosened it. We enacted this scene, me grabbing the wallet, he chasing me and grabbing me, putting on the handcuffs and tying me up, for several sessions. Joey added various elements and new dialogue at each session. When he tired of this game, Joey decided to play ‘principal’s office.’ He surrounded himself with the staple machine, toy telephone and various office-like items. He directed me to be the therapist in my own office who called him for advice about various children in his school. Joey delighted in this game as well, and we played it many sessions. During this time his mother reported that he was a transformed child, happy, no longer destructive, and calm.
We began to work on various other aspects of the therapy process in between other play scenes Joey invented, engaging in self defining activities and focusing on emotional expression, particularly anger. He was quite responsive and, in fact, often advised me, when we played ‘principal’s office’, to tell my troubled child (usually a large teddy bear) to draw pictures of his angry feelings, as well as other activities he, himself, had attempted. I saw Joey weekly for about one and a half years, including his parents every few sessions. At our last session Joey brought in a music tape he liked, and at his request, we danced to it the whole session with much more abandon and laughter!
It is tempting to interpret Joey’s dramatic play, much of it is quite obvious. Interpretative words seem superficial in comparison with the depth of this experience. A final note about Joey; he asked his mother why he was seeing me. She replied, ‘When you were little, you never had a chance to play. Violet is giving you that chance now.’
This article is from a book in process by the author. The concluding part of this article will be published in the next issue of Inside Out.
Violet Oaklander PhD is the author of Windows to our children, A Gestalt Approach to Children and Adolescents (1978) New York; (1988) The Gestalt Journal Press and is the Director of the Violet Oaklander Institute in Santa Barbara, California, USA. She may be contacted at 3761 Gregory Way, ♯5, Santa Barbara, CA 93105 USA.